Signs and Symptoms of Fifth Disease (Parvovirus B19)

Fifth disease, or erythema infectiosum, is a contagious viral infection best known for causing a blotchy red rash on the cheeks. As a result, it's sometimes referred to as "slapped cheek disease."

Other symptoms are cold- or flu-like, including fever, headache, cough, and sore throat. Fifth disease spreads from person to person through respiratory droplets containing parvovirus B19, a common, contagious virus.

Fifth disease is most common in preschool and school-aged children, though it can also affect adults. Symptoms start gradually and progress over time. As the infection progresses, the characteristic face rash appears after a few days before spreading to the torso and limbs.

Symptoms of fifth disease can differ in children and adults. Children are more likely to develop a rash, and adults are more likely to experience joint pain.

While the infection is mild in most people, it can be more severe for pregnant people, people with weakened immune systems, and those with certain blood disorders.

Cold- and Flu-Like Symptoms 

The initial symptoms of fifth disease are similar to those of the common cold or influenza (the flu). These symptoms develop 4-14 days after exposure to the virus. They may include: 

• Fever 
• Runny or stuffy nose
• Headache
• Sore throat
• Muscle aches
• Cough

These early symptoms are not unique to fifth disease and can easily be mistaken for other common viral infections. In most cases, they resolve without treatment within a few days.

Skin Rash 

One of the most recognizable signs of fifth disease is a bright red rash that first develops on the cheeks, giving them a “slapped cheek” appearance. This rash usually develops a few days after the onset of cold- and flu-like symptoms and is more common in children than adults.

The rash can be itchy and spread to the arms, legs, back, and chest. It appears in lacy patterns with slightly raised, red, blotchy areas on the skin. 

In most cases, the rash goes away within 7-10 days, but it may come and go for several weeks. Sunlight exposure, warm weather, intense exercise, and emotional stress can worsen the rash or make it more noticeable. 

Joint Pain 

Joint pain and swelling (polyarthropathy syndrome) affect up to 78% of adults and 10% of children with fifth disease.

In many adults, joint pain is the only symptom of fifth disease. People assigned female at birth (AFAB) are more likely to experience joint pain and swelling than people assigned male at birth (AMAB).

The pain usually develops about one to three weeks following the initial infection and affects joints in the hands, wrists, knees, and ankles. This moderate to severe joint pain usually resolves within a week or two, but some people experience persistent joint pain that lasts months or years. 

Is Fifth Disease Contagious?

Fifth disease is contagious and spreads from person to person through respiratory droplets, mucus, saliva, and sputum.

When a person with fifth disease coughs or sneezes, others can breathe in these respiratory droplets and get sick. These droplets can land on surfaces (e.g., doorknobs) and spread the virus when someone touches the contaminated surface and then touches their nose or mouth.

Fifth disease also spreads through blood and blood products, and pregnant parents can pass the virus onto their unborn babies.

People with fifth disease are contagious when they have cold-like symptoms, which is usually before the rash appears. The infectious period typically lasts until the rash appears, usually about a week after the onset of symptoms. After this period, they can safely return to work or school without the risk of infecting others.

Practicing good hygiene and taking precautions during the contagious period can help prevent the spread of fifth disease. This includes the following: 

• Wash your hands frequently with soap and water 
• Cover your mouth and nose with a tissue or the crook of your elbow when coughing or sneezing
• Refrain from touching your mouth, nose, and eyes with unwashed hands
• Avoid close contact with people who are sick 
• Stay home when you are sick 
• Clean high-touch surfaces regularly, including handrails, doorknobs, light switches, and countertops

When to Contact a Healthcare Provider 

Most cases of fifth disease are mild and resolve within a week or two without treatment. However, certain people at risk of severe illness or complications should contact a healthcare provider for a diagnosis and treatment recommendations.

Conditions that can increase the risk of complications include: 

• Pregnancy 
• Cancer
• Human immunodeficiency virus (HIV)
• Sickle cell disease
• Chronic (long-term) anemia
• Thalassemia (a rare blood disorder)
• Organ donor transplant recipients 

Sometimes fifth disease causes more severe symptoms in otherwise healthy people. See a healthcare provider if you or your child develop any of the following symptoms:

• Worsening symptoms or symptoms that do not improve despite home care measures
• Severe joint pain or swelling
• Pale skin 
• Extreme fatigue 
• Fever higher than 102 degrees Fahrenheit (38.9 degrees Celsius) for more than three days 

A Quick Review 

Fifth disease is a viral infection known for its distinctive “slapped cheek” rash. The virus spreads through respiratory droplets and is most common in children. 

Most people develop flu-like symptoms, including headache, sore throat, cough, and fever. Children usually develop a bright red rash on their cheeks a few days after these symptoms begin, while adults are more likely to develop joint pain and swelling. 

While fifth disease is usually mild and resolves within 1-2 weeks without treatment, it can sometimes cause more severe illness in pregnant people and those with certain medical conditions. Contact a healthcare provider if you suspect you or your child have fifth disease.